Document Detail


How I treat cobalamin (vitamin B12) deficiency.
MedLine Citation:
PMID:  18606874     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The challenges in medical management of cobalamin deficiency lie in attention to the unique pathophysiology that underlies cobalamin deficiency, more than in the mechanics of therapy. The central physiologic principles are that clinically important deficiency is more likely to occur (and progress) when intrinsic factor-driven absorption fails than when diet is poor and that most causes take years to produce clinically obvious deficiency. Transient defects have little clinical impact. The key management principle is the importance of follow-up, which also requires knowing how the deficiency arose. The virtues of these principles are not always fully appreciated. Recent developments have made diagnosis and management more difficult by diminishing the ability to determine cobalamin absorption status. Clinicians must also grapple with premature medicalization of isolated, mild biochemical changes that added many asymptomatic cases of still undetermined medical relevance to their caseload, often expanded by inflated cobalamin level criteria. The potential for misattribution of cobalamin-unrelated presentations to nongermane cobalamin and metabolite abnormalities has grown. Pathophysiologically based management requires systematic attention to each of its individual components: correctly diagnosing cobalamin deficiency, reversing it, defining its underlying cause, preventing relapse, managing the underlying disorder and its complications, and educating the patient.
Authors:
Ralph Carmel
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2008-07-07
Journal Detail:
Title:  Blood     Volume:  112     ISSN:  1528-0020     ISO Abbreviation:  Blood     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-09-09     Completed Date:  2008-10-30     Revised Date:  2013-06-05    
Medline Journal Info:
Nlm Unique ID:  7603509     Medline TA:  Blood     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2214-21     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, New York Methodist Hospital, Brooklyn, and Weill Medical College, Cornell University, New York, NY 11215, USA. rac9001@nyp.org
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MeSH Terms
Descriptor/Qualifier:
Disease Management
Humans
Malabsorption Syndromes
Practice Guidelines as Topic*
Treatment Outcome
Vitamin B 12 / metabolism,  therapeutic use
Vitamin B 12 Deficiency / diagnosis,  physiopathology,  therapy*
Grant Support
ID/Acronym/Agency:
DK32640/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
68-19-9/Vitamin B 12
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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